February 21, 2011

How am I Supposed to Pay For This?

Where is the money going to come from for this? How can they raise my rates 17% every year? Don't they want any customers?

I'd bet you have asked yourself these questions in one form or another over the last several years...when the subject is health care costs. Besides being a never-ending political hot button, those of us living in the real world have to deal with a system that is either broken, or at the very least dysfunctional. Even if you are lucky enough to still have a strong policy through a job or pension, every year there is an increase in costs and a decrease in benefits or coverage.

Costs Are Insane

My wife and I have been in the individual health insurance market for 31 of our almost 35 years of marriage. Today, just paying the premiums on policies with very high deductibles and no drug coverage consumes 20% of our gross income each year. Even with me covered by Medicare in 3 more years, by the time my wife is old enough for coverage I expect we'll be forking over closer to 30%. A simple 2 or 3 day stay in a hospital costs more than $10,000. The average hospital stay in this country is 5 days and the cost is $24,000. Two years before she died my Mom broke her leg. The cost was $110,000. Note I said she broke her leg...she didn't have a heart transplant or anything fancy. Just a broken bone that we probably all have had at least once while growing up.

Those numbers make no rational sense. The entire system is based on the premise that those without insurance pay more than those with coverage. Hospitals agree to provide certain services and costs paid for by an insurance company at an extreme discount and then make their profit on hugely inflated charges that you have to pay.

We all have to take responsibility for keeping as much of our money out of the pockets of doctors, hospitals and insurance companies. Exercise, eating well, keeping stress low, and so on are steps every one of must and can take to prevent financial ruin from a preventable health issue. Joan's Boomer Blog recently had a good link to a list of  health sites for seniors. If you didn't see it click here as a good starting point.

Your Turn To Help Us All

My questions for you, though, are more basic. Since we are all in this together maybe we can learn from each other. Maybe you have discovered a way to get decent health care without filing for bankruptcy. Maybe you have a horror story about costs or health care problems you want to scream about from the rooftop. How exactly do you cover your health care costs?

One favor: please avoid blaming a political party, president, or policy. While there is plenty of blame to go around and this problem has been festering for years, that is not my goal with this post. I hope we can help each other by comparing our situations.

Look at each of these scenarios. Which one describes you? Please answer one or more of the questions under that heading. You can leave your comment anonymously if you'd like. But, I really hope we can get a dialog going about this issue and share strategies.

If you are covered by Medicare:
  • Do you have supplemental coverage?
  • Do you purchase Part D?
  • Do you use an Advantage policy instead?
  • Are you worried about restrictions on what is covered?

If you are in the individual market (insurance not provided by work or government):
  • How rapidly are your premiums increasing each year?
  • What benefits or costs have increased while the policy gets more expensive?
  • Are you afraid your insurance company will stop covering individuals?

If you are covered through work or a pension:
  • Has coverage changed since you left work?
  • Have your costs gone up?
  • Are you worried your company may eliminate health coverage?

If you have no insurance (like 45 million of us):
  • Are you skipping medical tests, procedures, and pills due to cost?
  • What would you do if hit with a major medical expense?
  • Do you use the emergency room for treatment of non-emergencies?

I really am looking forward to lots of comments and lots of feedback. Be as open as you are comfortable being in explaining your situation and answering these questions. I can't think of a subject that affects a satisfying retirement any more than this.

.

30 comments:

  1. A lot of good questions here. I am one who has insurance supplemented by my previous employer but have seem my monthly contribution increase to twenty times more than it was ten years ago when I retired.

    See my post at http://waiting4god.net/2011/01/05/another-view-of-u-s-healthcare/ for what I see as the problem. As the corresponding graph shows we in the U.S. spend many many times more for our healthcare than any other country in the world and then don't live nearly as long as in other countries.
    I am convinced that most of that is due to how we manage our system. Almost every other country has some form of single payer system or at least very regulated system. Until we learn out lessons from the other industrialized countries in the world I don't think we will ever control our system. But we seem to be too vain to be able to learn our lessons form "someone else". :)

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  2. RJ,

    Thank you for starting the comments for this post in such a rational and reasoned manner. This subject seems to trigger extreme emotions in people. I'm hoping that most additions to the issue will add perspective to the debate instead of heat!

    A 20X increase in monthly contributions in just ten years must do wonders to your budgeting. Unfortunately, there are 40+ million who have no insurance, some of whom would gladly put themselves in your shoes.

    You make your case with the graph on your blog. Speaking of your blog, I like it a lot. I have added Waiting4God to my favorites list.

    Thanks, RJ, for visiting today.

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  3. Bob,

    I like the even-handed way you always tackle this subject. I want to add our family's experience, an experience I've mentioned previously. When my husband was forced by a reorganization to retire years ahead of the time he wanted to retire, he was at least fortunate enough to have worked for a company which offers a retiree benefit. That "benefit" still costs us about $800 a month and doesn't include dental. Still, we do feel so fortunate to have it, as his diabetes and other preexisting conditions would make finding private insurance nearly impossible. He didn't have a big pension, so this cuts mightily into our monthly budget, but we do feel that gratitude. We know we should be feeling that way because we're also footing the bill for private health insurance for one of our daughters and her oldest daughter. Her youngest daughter is fragile, requiring many therapies, doctors' visits, and sometimes surgeries. Her many appointments and outside therapies makes it impossible for my daughter to work at the kind of fulltime job that would provide insurance. Society and our family would not benefit anyway, because her daughter has made progress beyond any doctor's most optimistic prognosis, and she requires fewer therapies now than she did in the past. She is covered because of her multiple disabilities. My daughter's new husband is starting his own business, so is also without health insurance. For years, predating their marriage, we have paid for private insurance for our daughter and oldest granddaughter. It's about $500 a month, doesn't cover some of the medications my daughter and granddaughter need, doesn't cover dental, and isn't accepted by many doctors. It's basically catastrophic insurance at a non-catastrophic rate. My daughter is fearful of using it because she's afraid some premise will be found for cancelling it.

    The cost isn't the main concern. It's access. My daughter had complex migraines as a child, and had Scheuermann's disorder, which forced her to be in a back brace for a while. Those situations prompted several private health insurance companies to refuse her as a client. They prompted the insurance company she has now to exclude anything that might be remotely connected to either a complex migraine or back problems as pre-existing conditions. My daughter pays for all dental care for herself and her child out of pocket, pays for most of their medications out of pocket, and limits the number of times she'll visit the doctor so that she sometimes doesn't get the care she needs. Because she's footing all those bills, which mount up to consider numbers, she can't afford to assume the cost of her health care insurance, so it's an unending spiral. We honestly can't afford it, a financial planner would tell us, as it's coming straight out of our savings, but neither can we afford to let that insurance lapse. Our daughter was recently diagnosed with a serious and chronic illness, and I shudder to think what would have happened if she hadn't had insurance in place at the time.

    We're still the lucky ones. We do have savings, even if we're worried about what will happen in the future with these drawdowns. In our state, our son-in-law can not obtain group insurance for himself and his employees as he doesn't have enough full-time employees, so that route is out until his business grows. For us, the only helpful solution is a federal one that provides group rates for large numbers of people, stable insurance that families don't fear losing if they're sick.

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  4. Linda,

    I have absolutely nothing to add to this remarkable story except I will pray for you and your family. Your situation is a vivid snapshot of the problem that is overwhelming our current system.

    I am extremely grateful you have taken the time to share.

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  5. You are so right...there is plenty of blame to go around. In our state all state retired employees are allowed to purchase insurance through a group called Public Employees Retirement system. We have three companies to choose from and a variety of types of insurance. By creating such a large consortium, the cost is reduced. We also reduce costs because this group is non-profit and does not charge the large amount private insurance companies charge to administer Medicare. (That is the way the Fed Program would work as I understand it.) Everything is billed through PERS insurance so doctors and hospitals love us. So far it has been a win win!

    I seems to me that there is power in numbers and even a group like AARP can get you a better deal because of their large membership. We are finding the cost of dental care to be outrageous but only because our teeth wear out as we get older. My husband has even visited a clinic in Mexico and had a great experience there.

    We have also done some research into Canadian Prescription companies and it appears that the cost for my meds would be less that I pay after the insurance company has paid their portion...which is huge. We may give that a try if our doctor consents. I have not inquired about our insurance co. paying for those too.

    I think we are very lucky. I am for federal government intervention. We just need to bite the bullet and get it up and running completely.

    Thank you for the blog. I am going to link to your article and send others over your way.

    b

    http://www.retireinstyleblog.com

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  6. Thanks, b, for the comment and link.

    Your coverage situation sounds good. I agree that costs are responsive to numbers. The more purchasing power the better.

    I know a few older women who make a semi-annual trip to Mexico for prescription drugs and are quite pleased. The Nogales area is too dangerous so they go south of Yuma.

    My wife and I purchased drugs for a few years from Canadian pharmacies and never had a problem. The prices were quite attractive. After she managed to cut her pill intake dramatically we now get everything through Costco or Walmart as a generic. The costs are probably 80%-90% lower than brand names and 50% lower than through Canada.

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  7. I added the link again...I wanted to include the link in a blog so I did that too.

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  8. I hate to break this news to you, but it is the fault of our politicians that have put us into this predicament. They are the ones who make the laws that we all have to follow. If health insurance would be allowed to be sold over state lines, competition would set in, costs would go down and we could all afford health care. Obamacare is not working. Because of it, we all have seen our insurance premiums go up. And there is no end in sight.

    The only way around this, for me, was to become the new poor. Poorer people get more benefits today than the working slob. Again, it's the laws the politicians put in that have forced me to do this. being a new working poor person, has enabled me to qualify for state sponsored, low cast health care. But, unfortunately, even that mere pittance is going up also. I've compensated the higher costs by getting a higher deductible and eliminating drugs. I thought the drug part was just for prescription meds but again, alas, if you need medical attention of any kind, I have to pay for ALL medication. Wiseguys.

    Now that I'm broke and poor and still can't afford my healthcare (it's 20% of my monthly expenses, and climbing), I really don't know what to do. To be honest, I can't even afford my co-pays nor can I move to another state because what I have now is the best. Next step may be welfare. I heard they had a good dental plan.

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  9. I was hoping to keep direct political attacks and simplistic analysis out of this discussion. But, I'm not a big fan of censorship so if you take the time to add your comments, I'll take the time to take issue with some of your statements.

    My health insurance premiums started going up rapidly during the days of Bushcare. The most rapid increases for me and my wife were in the 2001-2007 time frame. Obama had nothing to do with it.

    Obamacare as you call it, has only been implemented about 15%. There is no way to know what will happen to costs because the current crop of politicians are determined to emasculate it before it takes effect in 2014. Is the law perfect? Absolutely not. It has serious flaws that should be addressed. But, to throw it out and allow the current insurance-company system to continue is a recipe for disaster.

    Stripping away some of the charges, your point is the same as I and all comments so far have made. The way the health care system has operated for the last several decades (Obama was a teenager) was destined to cause the problems we are experiencing today. To attempt to blame on one person or one 24 month period is counterproductive and untrue. We want an instant fix to a major flaw in our system. Sorry, but it doesn't work that way. And, it certainly isn't going to be cheap.

    I disagree with where you place the blame but I fully support your right to do so. That's why your comment and my response appear here.

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  10. As a follow up to the comment above from anonymous and my response, read this article in today's New York Times. This family's situation is not atypical, and that one of the problems: http://tinyurl.com/4dd8nu9

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  11. I read that the average couple over 65 can expect to pay $250,000 in out of pocket medical expenses like co-pays, prescriptions, etc. That is more than most have set aside for their entire retired life! I hope something gets done in congress or that the current healthcare plan gets a chance to prove itself - I am all for adjusting it along the way. I heard a guy on the radio the other day saying that there was no need for everyone paying for their own health coverage. He had no coverage, broke his leg in an accident and all of his bills were "taken care of". What he does not realize is that the money has to come from somewhere and it is those of us paying for coverage that ultimately foot the bill. This one is a long way from fixed and yet needs fixing more than a lot of other topics that are a focus of our politicians - such as re-elections in 2012! Good luck to us all...

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  12. Hi Dave,

    The case of the person who had no insurance but said it was all "taken care of" is a perfect example of the problem we face: too many insured and uninsured people have no real grasp of how much medical care really costs in this country. Those with solid policies are insulated from reality with $15 co-pays. Those with no insurance end up in the emergency room. That bill is ultimately all of ours to pay.

    Personally, my wife and I are terrified by the prospect of individual policies becoming unavailable (or completely unaffordable) over the next 8 years before she qualifies for Medicare.

    The new health care law has provisions for that concern but it's implementation has become a political football that has little to do with those of us facing these serious problems.

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  13. I don't know how Mr broken leg was "taken care of". My daughter did not know she was covered by our insurance before she turned 21. She went to the hospital and her appendices was removed- in the emergency room- with a general- and she was released when she was stable---six hours later. The bill arrived----$17,000. Our insurance went to bat and the total came to $400 out of pocket. BTW- the surgery did not go so well so there are complications with her reproductive system as well now. No, we did not sue.

    My nephew has gone bankrupt- TWICE- for his chronic illness. And lest one thinks he is a slacker, he became a pharmacist last year. He will never go without health care again.

    We have "free" military retiree care. It was a part of the promise(yearly written and received) made to us when my husband committed 20 years to the military. We had to move from Flagstaff because we could not find a provider who would take the insurance (good luck Medicare people w/ out supplemental in Flagstaff). We now pay a monthly amount for the insurance and it is supposed to go up 20% in the next year. We are not allowed to use the military health system when we turn 65.

    The "Obama care" blame really gets to me as well. Teacher's health insurance went from $69. a month to $425. in the early '00. I stopped taking it at that point.

    And the idea that "children" can be covered until 26. How crazy is that. If your parents are covered - great- if not- you are out of luck.

    My friend dropped her coverage for her workers when she knew they could get COBRA for 18 months---so much for small business. It was cheaper for her to pay COBRA then cover them.

    The single thing driving people to stay in the military is health care. As it gets cut- the numbers will dwindle. It will be interesting to see what type of person is in the military in five years. If you think fighting a war that is not even mentioned on the news anymore is incentive- think again. What happens when we actually need a military to protect US? BTW- when my son in law got out of the military the COBRA was $1979 for three months for a healthy family of three. If he did not land a job the plan was to go on Medicaid and us pay for catastrophic insurance. (We paid the COBRA- what 21 year old could afford that?)

    What I cannot get is the people who complain the most about universal care tend to be the elderly. They get hip replacements and pacemakers- while their "entitled" children go bankrupt for the same care. Who is entitled? Who can get SS and medicare without ever paying into the system?

    Hot topic in my house!

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  14. Bob- Aren't you at all worried that Medicare will be changed a great deal WHEN she gets to 65? We are!

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  15. Barb said...

    Gonna try not to get political here Bob-but since I lived (and my husband died) in a country with universal health insurance, I tend to get lost a bit. we could have retired in germany, and the offset of the dollar versus the euro would have been completely covered by the difference in the german health care system. Now, having said that..

    Im on a pension but pay for and receive the same medical benefits as we did when my husband was a federal employee. These fees go up or down a few bucks every year. I paid $400 per month for a "high option plan" and now pay $200 per month for a standard optin plan for two people (a family is a family, be they two or ten). My co pays are generally ten to twenty percent depending on the service, mostly ten.

    PS. The totall BILLED COST for the entire year my husband was ill (chemotherapy, surgery, private rooms, morphine, experiemental last treatments, you name it) for his treatments and those of our family were .......$26,000. That is the total cost of a family of four plus a terminally ill patient with cancer who had every treatment but a transplant..........give me socialized medicine...please!

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  16. Janette,

    Yes, we are quite concerned that Medicare will be much more restrictive when my wife is old enough to qualify for coverage. Of course, considering the amount of fraud connected with it today, everything could be paid for by just eliminating the system of paying whatever bill is submitted.

    Your comment detailing all the problems you, your family, and relatives faced is why this topic is so important. And, you are right: those who benefit the most from the current system selflessly want it to stay the same. Apparently they believe everyone else is in trouble through some unspecified fault of their own.

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  17. Barb,

    During the last two years of her life my Mom's care totaled over $200,000. Her cost after Medicare and supplemental: $2,700 (not including premiums of about $110/month). Still, she and my Dad complained when they had to pay $10 for a month of pills instead of $5. They were so insulated from the true cost of the system they have no comprehension of the obscene charges of care for most of us.

    You have a good pension situation but you are well aware you are luckier than many. You also have a solid grasp of what things really cost. I would kill for a policy like yours!

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  18. Hey, Bob... I recently had surgery and spent two nights in the hospital. The bill for hospital alone was $18,000. That doesn't include the surgeon, the anesthesiologist and who knows what else I might have forgotten. As I have Medicare with a supplemental insurance policy, I've been assuming that most (or perhaps all) of my medical expenses would be covered. I think that's probably correct. And therein lies a part of the cost problem -- third party payers.

    Were I to damage my bicycle, I'd take it over to the bike shop for an estimate. I'd learn about my options for repair and then make a decision -- either patch it up, fix it so it's perfect, or scrap (or sell) the bike and buy a new (or used) replacement. I'd make the decision based on a cost / benefit analysis. If any one of those options appeared to be too expensive, I'd eliminate it and move on to consideration of the next. That's the way it works when the person who pays for the service is the same person who receives benefit from the service.

    OK, now let's suppose I break my arm. I receive the service -- the re-setting of my broken arm -- but a third party -- an insurance company in Hartford, CT, gets to pay the bill. Hey, I'm hardly concerned about the cost. If I don't have to pay for it, the price isn't much more than an interesting statistic. In fact, for my recent surgery, I never once asked my doctor (or anyone else) what the procedure might cost.

    I believe there are two other reasons why health care costs an arm and a leg. The first relates to the purchase and application of modern technology. Every hospital and every doctor's office believe that they need the latest in technology. And there's a case to be made for that point of view. For medical professionals are, today, accomplishing some amazing feats of surgery.

    The last reason which med costs are so high has to do with our litigious society. Far too many people are suing far too many doctors, far too often. Because of this, the doctors respond by: (a) paying sky high medical malpractice insurance premiums and (2) practicing "defensive medicine" -- that is, ordering every possible test that might somehow relate to the patient's symptoms.

    Good luck to all of us, Bill

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  19. Bob,
    Don't want to add fuel to your carefully controlled fire but I just can't help commenting that the government through regulation makes so many more things much more expensive- all in the name of protecting us. Cars are a good example as are electricity and gas costs.(I worked for nearly 30 years for an electric utility) These decisions are made without any concern for the economic effects and the deliverers of service are left to deal with the consequences and the blame. If we shot every damn one of them and started over with a lottery, maybe we could return some common sense to the process.

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  20. Hi Bill,

    I didn't realize that the folks in the emergency room don't set broken bones anymore. They stabilize the break and send you to an orthopedic surgeon at a hospital Both my daughter and Mom waited 5 days in a hospital to have a broken bone in the foot and leg operated on. Besides the pain involved, the costs were absurd.

    When I broke my wrist when I was 12, it was set, a cast put on, and I was sent on my way in under 2 hours. No more.

    The third party payer, whether it is the government or a private company are certainly part of the problem. Virtually no one comparison shops when the problem is medical. Those of us who pay a lot of costs ourselves do ask and do look for ways to shave costs.

    Good luck to all of us...you got it!

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  21. Evening, Ralph,

    You'll get no argument from me that bureaucratic red tape costs all of us and is often counterproductive and implemented with no thought to the effect.

    At the same time I welcome the government's role in making sure those cars and airplanes and electric delivery systems are safer than they would be if left strictly to the private sector.

    A balance between oversight and common sense is what is missing.

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  22. Bob, the amount I paid was only two thousand dollars. The twenty five grand was what was billed to my insurance company.........

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  23. Barb,

    That makes your argument even stronger. Once you experience coverage that good it must be difficult to understand those who oppose it.

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  24. I'm sorry to hear how expensive medical care is.

    Sometimes the British Government can come up with good ideas, the National Health System is one of them. It was installed by a Labour government immediately after the Second World War. The government wanted a country 'fit for heroes'.

    The UK Government is broke now with nothing left in the kitty, but our healthcare is still free, including drugs and operations.

    I hope you find a low cost solution to your health maintenance.

    John
    Leamington Spa, England

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  25. Hello, John.

    The U.S. is broke without free healthcare...go figure!

    I have been wondering what the U.K. is going to do to fix it's fiscal woes. Do you think the National Health System may be restructured and the days of everything being free coming to an end?

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  26. My wife and I chose a little over a year ago to drop our health insurance. We are in our late fifties (60 this year) and were paying $1000 for a catastrophic policy that paid nothing util we reached $7000 deductible each, not a combined deductible. Every year we would lower our coverage so that we could afford the premiums. We have never reached the deductible and we've paid 100% of our doctor and perscription costs on top of the 12k we sent to the insurance company. Some months we would have to take money out of our savings to send to the insurance company or pay medical bills. I estimate we have sent over 125k to the insurance company in the last 10 years and in that time have received about 12k in assistance. We both felt this was crazy and we were going broke slowly. We live in a rural area of northern CA and if we lived in Sacramento our premiums would be almost cut in half. What we need is a system that is fair to all of us. I really don't understand why, in the same state, rates are so different. I believe this is the way insurance is regulated by the states. If we have a serious illness or accident we will have to go into bankruptcy which will ruin our lives and the rest of the cost will be carried by ???? Why not let us buy our own insurance at a resonable rate or allow us to become part of a group with bargining power.

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  27. Your story needs no additional comment from me. You have made it quite clear that the current system is badly broken. In my view it is criminal that this life and death issue has become a political football.

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  28. I realize that this blog is from quite some time ago, but I just discovered your site today. We retired a year ago and are still on Cobra - I am nearly 58 and my husband is 57. Although I planned on paying health insurance, I planned on getting a high deductible plan that did not cost much. We rarely go to the doctor, and frankly, I am very much into trying alternative medicine (not covered by insurance)and using traditional medicine as a last resort. Our insurance on Cobra is $988 per month and when it is done, we will have go on the Oregon High Risk Insurance Pool ($1100+ per month)which is more expensive with less coverage. When we retired last year, we both applied for $10K deductible individual policies and were both denied - it is nearly impossible for someone over 55 to get individual insurance, because almost anyone who is that age has had some kind of an issue in their life. I had planned on paying about $500 per month until 2014 when the new health plan goes into effect. At this point I am really debating whether to take our chances for the next two+ years and save approx $30K in premiums. If the health care plan does not go into effect, we will not be able to afford insurance till we are 65 anyhow. I increased the medical coverage on our auto insurance to $100K (cost very little)which is probably the most likely way a catastrophic medical expense might come from at the moment. I have looked at what would happen if we did drop our insurance and something did happen - in our state, only $50K equity in a home is protected in a bankruptcy, so the house would be an issue, although we could use our equity line enough to get us to within the $50K and use that as a partial payment for the medical expenses. However the majority of our retirement money is in IRA's which are protected under bankruptcy. I used to work for a hospital, so I know how much more they charge individuals than insurance companies. I would negotiate the amount and make payments before resorting to bankruptcy. I fear that making the payments on the insurance and then having the health plan not being implemented or available until later would put us in a precarious financial position. My thinking is it would be better to hang onto that money for future health issues that may or may not happen than to insure that I will be out that money. Am I crazy to consider going uninsured for 2+ years?

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  29. Donnine,

    Welcome to the blog. I'm so glad you found it. This post from February remains visited quite often because the topic is so critical to us all.

    You are not alone in this debate of keeping very expensive coverage or going without and hoping for the best. Some folks figure they can self-insure themselves with the amount they are not paying in premiums. In your case that would be up to $30,000 available.

    Unfortunately, a two or three day stay in the hospital can cost that much. A heart problem will top $100.000 without skipping a beat (pun intended). Heavens, just a one dental tooth implant can be at least $7,000.

    And, you are absolutely right about getting coverage. There isn't a human being alive without something in their medical past that will cause a rejection by the insurance companies. They want nothing to do with anyone over the age of 30 or anyone who has ever had as much as a hangnail.

    Uncomfortable as it may be on your finances, the political climate is so poor right now I wouldn't count on 2014 being anything more than the year that follows 2013. Personally, I believe that most American under 65 will be without medical insurance within the next 5-10 years. That will bankrupt tens of millions and the hospitals that must treat them. Only then, will politics be set aside to do what should have been done years ago.

    My advice..keep the insurance. Keep your fingers crossed. Stay away from the medical establishment for anything except a dire emergency, and bless the day you reach 65. I have 2 1/2 years to go...and am counting every day.

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